摘要
目的了解国内医生诊治痛风的决策并对相关因素进行分析。方法对197名医生进行了关于痛风诊治决策的现场问卷调查,同时收集答卷人的个人资料,通过双变量分析和多重Logistic回归分析模型,分析影响决策的相关因素。结果一共收回120份有效答卷。在诊断痛风时,94名医生(78．3％)认为应该检查患者的关节滑液。在治疗急性痛风发作时,如果患者肾功能良好,83名医生(69．2％)首选口服秋水仙碱;如果患者肾功能不全,50名医生(41．7％)首选皮质激素或促皮质激素。在降血尿酸治疗时,99名医生(82．5％)选择的指征不当,107名医生(89．2％)治疗开始得太早,92名医生(76．7％)用药的时间不够长。另外,在开始降血尿酸治疗的同时,仅有17名医生(14．2％)预防急性痛风的发作。多重Logistic回归分析发现痛风继续教育是医生采取正确诊断方法的相关因素。结论国内医生诊治痛风的决策与目前国际较为公认的意见并不一致,高质量的医学继续教育有可能提高医生诊治痛风的决策水平。
Objective To investigate the decision-making about gout by physicians of China and influencing factors thereof. Methods A questionnaire survey, including 13 multiple choice questions, was divided into 2 stages. The first/stage questionnaire survey was conducted among 121 physicians of the departments of internal medicine and rheumatology respectively during the grand ward rounds, and the second-stage questionnaire survey was conducted among 75 physicians attending a national continuous medical education （CME） workshop of rheumatology. The data thus collected were pooled and analyzed by logistic regression models. Results 62 effective questionnaires were collected in the first/stage survey, and 38 effective questionnaires were collected in the second-stage survey, both with a missing rate 〈 10%. 78.3% of the respondents considered aspiration of the joint fluid as critical for the definitive diagnosis of gout, but only 2.4% of the respondents did so frequently. When treating acute gout in otherwise healthy patients, 69. 2% of the respondents preferred oral colchicine, and while treating the patients with renal dysfunction, 41.7% of the respondents used corticosteroids or corticotrophin as the first choice. For longterm uric acid-lowering therapy, 99 of them （ 82. 5% ） described a variety of incorrect indications, 107 of them （89. 2% ） initiated the treatment too early （ ≤2 weeks after the remission）, and 92 of them （76.7%） failed to sustain the treatment for at least 5 years. Only 17 physicians （ 14. 2% ） used prophylaxis while initiating the uric acid-lowering treatment and only 7 of them （5.8%） selected a prophylaxis time of 7 ～ 12 months. Multiple logistic regression analysis showed that only CMD on gout was associated with correct diagnosis strategy （ OR 7.1,95% CI 2. 1 ～ 23.7 ）. Conclusion The management of gout by the physicians in China is often not consistent with that generally accepted internationally. High quality CME may improve the decision-making ability of physicians.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2006年第27期1901-1905,共5页
National Medical Journal of China
基金
国家科技部科研院所社会公益研究专项(2004DIB1J040)
关键词
痛风
决策
问卷
Gout
Decision Making
Questionnaires
